Current practices and access to cardiac bone scintigraphy for diagnosing transthyretin cardiac amyloidosis: results of a large national survey

Transthyretin amyloid cardiomyopathy (ATTR-CM) is increasingly diagnosed using bone scintigraphy. Nuclear medicine (NM) physicians play a central role in the diagnosis of cardiac amyloidosis. The DIAM-ATTR national survey aimed to assess current practices and reporting patterns for diagnosing ATTR-CM among NM physicians in France. A cross-sectional online survey was distributed to all NM physicians in France between March and May 2024. The survey addressed scintigraphy acquisition protocols, radiotracer use, image interpretation, and reporting habits for suspected ATTR-CM. Among the 774 NM physicians invited, 100 completed the survey (12.9%). Most respondents adhered to the recommended acquisition protocols, including late planar imaging (99%) and routine Perugini grading (98%). Single photon emission computed tomography imaging was consistently performed (89% for patients with Perugini Grade 1 uptake and 85% for Grades 2–3). However, reporting practices varied: only 49% of respondents mentioned the need to screen for monoclonal gammopathy when the Perugini was Grade 1, and only 17% systematically advised re-evaluation by a cardiologist. Respondents identified standardization of imaging protocols and reporting content as key areas for improvement. In France, NM physicians largely follow guidelines for ATTR-CM scintigraphy, especially regarding the use of SPECT and Perugini grading. However, gaps remain in reporting, notably for excluding monoclonal gammopathy and guiding Grade 1 cases. Improved education, collaboration, and standardized reporting are needed to further optimize diagnosis and outcomes.